For the vast majority of our patients a good insurance policy makes it possible to receive comprehensive medical care. Irvine Pediatrics is fortunate to have contracts and a good working relationship with most of the major insurance companies in the area. We understand that facing ever rising costs, insurance companies often impose rules and restrictions that we all need to follow.
Please understand that in order to maintain contracts with insurance providers we have to collect co-payments, without exceptions! It is required that co-payments are made during your visit and there will be an extra $5 fee for all copayments if we have to bill you after the date of service.
Insurance Coverage
Since there are many different types of insurance policies, please know if you have an HMO, a PPO, a POS or EPO plan. Many of these plans require you to select a primary care physician and if you come to us in error and none of our doctors is your primary care provider, you may end up responsible for the whole bill.
You should also know whether you have added network benefits under your plan, if you have met your deductible, or if preventative care is covered under your policy. Please be aware that there are many essential services that are not covered by many, even very good policies. You should be aware which hospital in this area contracts with your insurance company. In general, do not go to a hospital Emergency Room without calling your doctor to see if it is necessary, unless of course it is a life threatening emergency.
Because of frequent coverage changes we ask that you bring your child’s insurance card at each visit. When you check in at the front desk, we will verify your child’s insurance card and usually we will copy it. It is your responsibility to know whether Irvine Pediatrics doctors are on your plan. If that is not the case, your insurance will likely refuse coverage and you will be responsible for the bill. If you do not have an insurance card at your child’s visit, you may be asked to pay at the time of service and/or sign a waiver of responsibility. Please be advised that we do not bill secondary policies.
If there are any changes in your insurance coverage, please bring them to our attention and provide us with a new insurance card as soon as possible. Most insurance companies leave us only a few months to submit the bill for the services, and will deny a payment if the bill is submitted to an incorrect company or after the due date! Regrettably, any delays caused by incorrect information of coverage will result in you being fully responsible for the payment.
Special Message for Our HMO Patients
Doctors of Irvine Pediatrics are very proud to be providers for the patients of Greater Newport Physicians HMO. As you well know the primary hospital for GNP patients is Hoag Memorial Hospital in Newport Beach. Please note that Hoag Hospital no longer has a pediatric ward. Instead they have made a special arrangement with Children’s Hospital of Orange County in Orange to admit very sick children there. The medical staff at CHOC is fully contracted with Greater Newport Physicians and they will provide the best possible pediatric care for our patients. Ambulatory testing such as X-rays or blood tests are usually provided either by Quest Labs, Hoag Hospital or Hoag Imaging Center. More complex procedures may have to be done at CHOC. We feel that this is a very good arrangement.
Please note that we are not contracted with any other HMO, and if your coverage is with Monarch or Bristol Park, it is your responsibility to bring that to our attention. Until you change your HMO, please be prepared to pay for each visit at the time of service. Any failure by our staff to identify your HMO from your insurance card will not waive responsibility for payment of your services.
Most but not all, insurance companies will pay for preventative care. Please note that some insurance policies do not cover this type of service. Although insurance claims will be submitted by our office, it is the parent’s responsibility to understand the details of their coverage benefits. Furthermore, in spite of medical recommendations, insurance companies can take months before covering a new product, vaccines, or new medications. We encourage you to contact the insurance carriers to determine any changes in your coverage, particularly when new vaccines are available. Please understand you may be required to accept full financial responsibility for these services if they are not covered under your plan.
Cash Patients
Full payment is expected at the time of service for patients without insurance coverage. Regrettably, it is illegal for us to apply cash discounts.
Credit Cards
We accept VISA and MasterCard. Payment by credit card can be made over the phone directly with our billing office.
Returned Check Fees
A $25 fee will be applied to all returned checks. It is the patient’s responsibility to pay the return fee and the service fee with either cash or credit card as soon as the situation allows.
Forms
Most schools require updated immunization forms. There is a nominal, $5 fee for all school or similar forms such as sports or camp forms. Please submit this payment along with the form; you can download most of these forms from our website. During a busy time, such as at the beginning of a school year it may take up to ten working days to complete the form. There will be a $10 fee to have the form on the same day.
Billing Inquiries
If you have billing related questions, please submit them in writing either by mail to our office or fax it directly to the billing office at 714-542-3216.
You may also call the billing office at 714-542-1975.
It is likely that our billers will be busy, and you will need to leave a message. When leaving a message start with your name and your child’s name, your account number (if available) and your call back number. You will have an opportunity to discuss details when they call you back.
Outside Services
Please be advised that even though our office will refer you to an outside laboratory, MRJ, or Radiology services, we have neither a financial interest nor professional control over their work, behavior, or billing practices. It is between you and the outside provider. On the other hand if you are unhappy with them, please let us know.